Diagnosed with Bipolar - What Next?
I've Been Diagnosed with Bipolar - What's Next?
Catherine Ness, MA, LCPC
A diagnosis of bipolar can seem overwhelming. You probably have many questions ranging from the prognosis to the disorder, to the medication your psychiatrist prescribed to how you ended up getting this diagnosis.
Bipolar disorder, like many disorders, is heavily based on genetics. It is likely that someone in your family has this diagnosis or demonstrates behaviors that are indicative of this diagnosis. There is nothing you did to give yourself this disorder; however, there is much you can do to manage this disorder.
Knowing about this disorder increases successful treatment outcomes. There are also various types of bipolar disorder with varying degrees of severity.
Types of Bipolar Disorder
Bipolar I Disorder
Many people who are diagnosed with Bipolar I Disorder describe feelings of depression most of the time. Symptoms of clinical depression include feelings of hopelessness, lack of motivation, over or under sleeping and eating, crying spells, fatigue, irritability, inability to concentrate and negative thoughts about oneself which can include a desire to harm oneself.
What differentiates depression from bipolar is that persons diagnosed with bipolar have periods of time, lasting from days to months, where there is an observable change in behavior and thoughts. These unexpected changes in mood and energy level are referred to as a manic episode. For some people this change in behavior feels like complete euphoria; you feel like you can accomplish anything and you have endless energy. For others this manic state is less pleasurable and simply includes racing thoughts, inability to sit still, severe irritability, impulsive behaviors and in more severe cases psychotic episodes.
To be diagnosed with Bipolar I Disorder only requires the experience of a single manic episode. Depression is not a prerequisite for this diagnosis, but is more often than not prevalent.
Bipolar II Disorder
Bipolar II Disorder involves shifts in mood from depression to hypomania. Hypomania is a term to describe manic episodes that last for four or less days. If symptoms persist longer than this it is considered a full manic episode and meets criteria for bipolar I. Hypomania is characterized by a distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the person's usual mood. Mania, on the other hand, includes symptoms of psychotic or impaired thinking, grandiosity, poor judgment and impaired day to day functioning
Rapid Cycling Bipolar
A term used to describe the rate at which mood swings occur is rapid cycling, which involves more frequent ups and downs; a significant change in mood occurring over a month, week or even in a day. It is not uncommon for people to have mood swings based on something good or bad happening throughout the day. Persons diagnosed with bipolar disorder, however, have extreme mood changes that meet clinical criteria for depression and mania. These individuals also have trouble finding a "moderate mood," in other words, feeling neither depressed nor overly excited/happy for an extended period of time.
Cyclothymic disorder describes more moderate mood swings from hypomania to a more mild form of depression. Persons diagnosed with cyclothymic disorder usually notice more frequent mood swings than those diagnosed with bipolar I and II. With this disorder, there is a higher level of functioning (less impairment).
The reason it is important to identify if someone has had even one single manic episode is most significant in finding an effective medication. An anti-depressant may be appropriate for a diagnosis of depression, but if someone has had a manic episode in the past, an anti-depressant may actually trigger a manic episode. In these cases, a mood-stabilizer tends to be a more effective option.
There are many different types of mood stabilizers available and, unfortunately, there is no way to know which medication will work most effectively for an individual. Therefore, it is important that you see a psychiatrist who will work with you to determine the effectiveness of the medication. Also, it is important to have a dialogue with a counselor about progress or possible need to change medication.
Psychotherapy or counseling for Bipolar Disorder is very similar to the treatment of depression. When I work with individuals who are experiencing depression, I try to understand how this profound sadness is affecting their lives. I connect with each client so that I can better understand their specific concerns. In addition, I help clients identify triggers for their depression or manic episodes so that they can feel more in control of their lives and no longer a victim of their emotions. I utilize cognitive behavioral techniques (CBT) to help manage the negative, anxious, and fearful thoughts that are common with Bipolar Disorder. CBT is an ideal therapy approach to help with negative thinking, feelings of powerlessness and hopelessness. I instill a hope that, even with this disorder, life can be manageable and happiness and success can be obtained.
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